Sacramento—Attorney General Edmund G. Brown Jr. today announced that last year, his office recovered more than $209 million in “hard-earned taxpayer dollars” and secured 139 criminal convictions by aggressively investigating and prosecuting Medi-Cal fraud cases.

Brown also reported that in 2009, his Bureau of Medi-Cal Fraud and Elder Abuse returned more than $12 million to victims of elder abuse and secured 47 criminal convictions in elder abuse cases.

“In these tough budget times, the state can’t afford to lose millions in hard-earned taxpayer dollars from people who try to cheat and steal from the system,” Brown said. “Thanks to the tireless work of DOJ investigators, we protected our most vulnerable citizens and recovered critical public health dollars.”

Brown’s Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA) investigates and prosecutes those who cheat taxpayers out of millions of dollars each year and divert scarce healthcare resources from the needy. The Bureau also protects patients in nursing homes and other long-term care facilities from abuse and neglect.

Combined, Brown recovered more than $221 million in Medi-Cal fraud and elder abuse cases. The amount recovered last year is more than six times the BMFEA’s $33.1 million operating budget. This represents a recovery of $36 for every $1 expended from the state's general funds.

The recoveries stem from restitution obtained in Medi-Cal fraud, elder abuse, and patient fund cases. Patient fund cases occur when a disabled person's finances are being controlled by a trustee who steals from the patient's trust account. Annually, the BMFEA conducts more than 1,500 investigations.

Medi-Cal Fraud

Last year’s $209 million recovery stemmed from civil lawsuits Brown’s office filed against companies and individuals that billed the state’s Medi-Cal fund for unnecessary services or for services that were never performed.

In one such case filed in October 2009, Brown’s office arrested the former manager of a Mount Shasta-based medical clinic after she billed Medi-Cal $2.2 million for services never performed. Denise Fairhurst, 57, of Redding, filed false Medi-Cal claims with the state to help cover the medical clinic’s operations and management costs. In addition, she used $33,492 of the funds to pay personal credit card bills. Fairhurst is scheduled to be sentenced on March 24 in Siskiyou County Superior Court.

Some of the fraud is perpetrated by criminal fraud rings. In May 2009, Brown filed criminal charges against six individuals who paid healthy seniors to be admitted into a hospice for the terminally ill and then billed state healthcare programs more than $1 million for procedures never performed. Some of the individuals used the proceeds of the scheme to purchase expensive cars, designer clothing, and luxury homes. Four of the defendants have pled guilty, and the state has recovered the $1 million.

A number of Medi-Cal fraud cases are institutional. In December 2009, Brown reached a $21.3 million settlement with pharmaceutical giant Schering-Plough Corporation, resolving allegations the company deliberately inflated the price of Albuterol and other drugs, overcharging Medi-Cal millions of dollars in pharmacy reimbursement.

Most of the funds recovered go back into the state’s Medi-Cal fund, which provides medical payments for nearly 20 percent of California’s children, lower income individuals and families, the elderly and disabled.

Elder Abuse

Although elder abuse can take many forms, the majority of cases involve abuses at California’s skilled nursing facilities. Brown’s office uses its civil, administrative and criminal enforcement powers to bring poorly performing care facilities into compliance with federal and state laws.

A few elder abuse cases Brown’s office prosecuted include:
• Mary Louise Wilson, who was sentenced to nineteen years and four months in prison for setting multiple fires at Southern California nursing homes, including the beds of elderly patients who were unable to get out of bed without assistance;
• Pamela Ott, who was charged with eight felony counts of elder abuse in September 2009 for allowing staff to forcibly administer psychotropic medications to patients for their own convenience, rather than for their patients' therapeutic interests; and,
• Leander Jackson, who was sentenced to three years, eight months in prison for identity theft and grand theft for operating several unlicensed skilled nursing facilities and neglecting to provide the proper care to the residents. Jackson used the identities of the patients to obtain cash loans and car leases.